If you’re trying to work out why the tips of your toes are sore, chances are it could be a condition known as chilblains. In this article we’ll be distilling decades of podiatry practice into how you can attain effective chilblain treatment.
Let’s get into it!
What are chilblains?
A chilblain is the more common term for a condition known as erythema pernio (or just pernio). As the name suggestion, chilblains are related to temperature, although not just the cold weather.
The simplest understanding of what actually a chilblain is that it is damage to the skin from poor arterial perfusion related to temperature change. As a podiatrist we’ll be focussing on the most common but certainly not the only location that pernio presents. Chilblains on toes.
What are the symptoms of chilblains?
Chilblain start off as a tingle like sensation at the tip of the toes. The skin is initially pale although turns more red and purple as they progress. Eventually the skin can break down to form open lesions where deeper tissue and blood is evident.
Throughout this the symptoms range from occasional tingles, to burning and numbness all the way to very painful sharp and burning sensations.
What causes them?
The short explanation is temperature changes cause chilblains. Some of us are more likely to get chilblains than others and there are contributing factors. But, temperature change is necessary for all chilblains to form.
Here’s the long explanation
Our body is usually excellent at deciding where we prioritise our blood volume. After we eat it heads to the gut. When we exercise that blood goes to our muscles.
For our thermostat, our ability to maintain an even body temperature unlike our reptilian friends there are lots of automatic decisions happening with our blood volume as well. When we are warm we send our blood closer to the surface. Have you noticed how visible veins are when we exercise? When we are cold we divert that extra blood volume to our core, keeping our vital organs warm and avoiding temperature loss.
All of these decisions happen automatically and are adjusted regularly in real time.
With chilblains our system starts making errors. Essentially closing off blood vessels towards the outer extremities for too long. When these superficial blood vessels are closed for long periods of time the tissues miss out on their nutrients and their health suffers. Skin starts thinning and breaking down. Toenail growth slows.
So if we are forcing our automatic blood distributing system to regularly make the decision to open (vasodilate) and close (vasoconstrict) these vessels, there is greater opportunity for errors to occur.
Moving from hot to cold to hot are exactly these situations.
For example
It might be having a raging hot shower but standing on cold tiles before and after. Or having the hot air on your feet in the car only to get out and stand for an hour in the cold wet grass while watching the local footy. For some it’s going from a cool house to a hot water bottle in bed.
Any change in temperature poses a risk that the chilblain process can start… But there’s more.
If you already have poor circulation or blood flow, in particular arterial perfusion you’re more likely to suffer. Those who smoke or have diabetes are prime candidate for chilblains.
The condition known as Raynaud’s phenomenon where the body is even more predisposed to making errors with blood volume is another.
Heavy drinkers and certain medications can also increase the likelihood of developing chilblains.
How are chilblains diagnosed?
Your podiatrist will perform a clinical diagnosis to determine if the lesions on your toes are chilblains or something similar. Often tinea pedis or psoriasis can present looking and feeling very similar to chilblains.
If you are suspicious about your toes thinking it might be chilblains then arranging an appointment with your PridePlus Health podiatrist is the first port of call.
Preparing for your appointment
Ensure when you’re coming in to see your podiatrist you have any current medications you’re taking. Have a good think about how long you’ve noticed your toes being the way they are. Has it happened before? Is there anything helping or making them worse that you have found?
Come prepared with shoes and socks, both what you are wearing on the day as well as what you prefer to wear to work, to exercise and casual options. The will make more sense in a moment.
Chilblain Treatment
Self-care for chilblains
The most important treatment for your chilblains are self driven. Recognising the specifics for you will usually require a podiatrists input however the actual treatment is what you can do for your toes.
The concept to recognise for effective chilblain treatment is temperature regulation. Avoid the shunting from cold to hot. A constant warm temperature is preferred as a starting point.
Depending on your other risk factors this could be as simple as increasing the wearing of warm socks. For others it might require a wardrobe change up with high quality insulation layers, winter (insulated) shoes and changes to your daily routine.
Here’s a menu of likely positive and negative chilblain treatment options. Choose more of the positive that you can and avoid the negative.
Good chilblain treatment
Insulating socks
Merino wool is better than technical (synthetic blends) which are better than bamboo and cotton which is better than stockings and nylon.
Insulated shoes and boots
Less common in Australia compared with other less temperate countries. Insulated boots and shoes will help keep your feet an even dry temperature. Shoes with an upper / outer shell of leathers and an inner lining of wool, sythetics like goretex are good options. They’re often marketed as winter boots in Australia. For runners going for trail running options which have goretex waterproof linings for cold and wet weather helps.
Exercise / Movement
Moving causes your heart rate to increase and your muscles to pump blood around your body. While it’s not reasonable to simple try to “outrun pernio” reducing sedentary activities is a great start.
If you’re looking to get started seeing an Exercise Physiologist is the best path forwards.
Skin Care
Ensuring good skin hygiene is always important but more so when tissue damage starts to occur. Moisturisers rich in essential acids like urea and soap free washes are great starts.
Medicaments
Some medicated creams can be used to stimulate vasodilation (opening of the blood vessels) to treat your chilblains.
Medicaments such as deep heat or tiger balm can sometimes be used in the early, tingling phase of chilblains. If chilblains deteriorate into open lesions then they are to be avoided. For open lesions first aid of antiseptics like betadine and covering with dressings is required.
Seeing Your Podiatrist
Have someone set the plan for you. Identifying what needs to change and showing you the path.
Poor chilblain treatment
Quick Fixes
Fast heating of cold feet with hot water bottles or resting in front of a heater can make chilblains worse.
Cold Tiles
Moving from warm environments like a hot shower onto cold bathroom tiles is just the sort of trigger for vasoconstriction that can lead to chilblains. Avoid. Use bathmats and insulated wool slippers instead.
Wet Feet
Dry your feet properly and if the get wet, change your shoes and socks to dry ones. Wet skin is more fragile than dry and can also allow heat to dissipate faster leading to colder and colder toes.
Barefoot / Sandals
Probably pretty self explanatory but if we want to avoid getting cold feet with changes of temperature then sandals, thongs and being barefoot is not a good idea.
Sedentary Lifestyle
When we move less, our blood moves less. We need good blood flow to the toes for effective chilblain treatment so getting up and moving more helps.
Smoking
If what we’re about to tell you is a surprise please immediately go talk to your GP about quitting smoking. Smoking is bad for chilblains as it leads to poor circulation. Not just over time but immediately after every cigarette there is less blood flowing to your toes. Cutting out completely is best but even reducing your cigarette intake will help your chilblains.
The final word on chilblain treatment
An increasing issue for many of us in and around Melbourne, chilblain treatment is simple in theory but harder in practice. Being prepared with appropriate shoes, socks and enough positive behaviours for our toes is paramount.
If you’ve never successfully prevented chilblains from causing you pain in winter time then start with your PridePlus Health podiatrist. We love problem solving with you.
Oh, and some high quality merino wool socks too.
